AIDS: A Man-Made Disaster?

Article concerning The River: A Journey Back to the Source of HIV and AIDS

The Scotsman, 24 June 2000, Magazine pp. 16-21.

WHEN THE BLOOD LEFT Bill Hamilton it drained away as fast as a reputation, starving his great mind of oxygen and leaving his body in a coma. Hailed as the "most distinguished Darwinian since Darwin", Hamilton had just returned to the UK from the Congo where he had been seeking evidence that another great scientist had inadvertently triggered the deaths of 16 million people.

As Hamilton lay unconscious that other scientist took a bow from a grateful nation. "The world owes Dr Hilary Koprowski an enormous debt of gratitude," an United States Senator declared in a tribute written forever into the Congressional Record. Nine days later Hamilton died. An autopsy showed that it was an excruciatingly unlucky death for the great naturalist. Wracked with malaria following the trip to Kisangani, a pill he had taken had lodged in his gut and burnt its way through into a major blood vessel, instantly filling his body cavity with blood. Although he would live for six further weeks, the damage done to his brain was irreparable. In his 63 years, Hamilton had cleared up many of the problems left by The Origin of the Species - he was best known for marking out the role played by altruistic self-sacrifice in a world governed by the survival of the fittest.

Altruistic self-sacrifice seems an interesting notion in this story where intense competition and sloppy science stand accused of visiting a plague upon a world living with the prospect of live AIDS vaccines, genetic modification and xenotransplantation. Science is a calling where an individual can leave a mark that lasts forever. In a different world the marks made by Hilary Koprowski should have helped all of mankind. Koprowski was a 33 years-old research scientist when he fed the first child a live polio vaccine. At the time polio was the most feared killer in the Western World. Basic hygiene had wiped out the natural reservoir of immunity in the population, allowing epidemics to paralyse and kill thousands - in the US alone over 10,000 of the nation's young were being affected every year. That was 50 years ago. This year the World Health Organisation expects polio to be eradicated - in no small part due to Koprowski's work.

The Polish-born scientist, an angular, intense-looking man was, at the time, in a keenly fought race with Albert Sabin to cure the world. Sabin won seeing his vaccines cleared to don sugar lumps the world over. At the time Koprowski showed magnanimity; on visiting Brazil Sabin fell asleep to the sound of children singing under his hotel window - adulation Koprowski claimed he would have found it too difficult to live with.

Instead he would go on to a glittering career. As director of the Wistar Institute, the oldest privately funded medical research centre in America, he would create vaccines that would tackle rabies and German measles and produce man-made antibodies to fight cancer. But while he worked, a new disease began to affect the homosexual communities of New York and Los Angeles; then heroin addicts, haemophiliacs. Curiously, Haitians also began to fall ill. The affected were soon referred to as 'The four Hs' - conjuring up images of the four Horsemen of the Apocalypse - but this turned out to be Pestilence's show, riding in on curiously global, yet hidden, sharing of blood.

As HIV spread and AIDS blossomed, a variety of cock-eyed theories sprung up. From the religious reactionaries who saw it as a God-given plague to the KGB's naughty suggestions that it was a botched biological weapons experiment by the CIA, whispers circulated, and for a moment stuck. As the 80s became the 90s a new rumour spread, one that was to crash in upon Koprowski's life. According to this theory, polio vaccine trials Koprowski had conducted in Africa in the late 1950s had taken the virus from its natural chimpanzee host and placed in the bloodstream of children. In essence not only was HIV doctor-caused, but he was the doctor that caused it.

For some reason Koprowski, a brilliant linguist, has never reached a standard in English which allows him to communicate without difficulty. Speaking about the accusations from his office at the Thomas Jefferson University in Philadelphia, the 83 year-old complained of being turned into an ogre. He had been in Germany when he story first broke in the pages of Rolling Stone magazine. "I was utterly shocked," he said.

AIDS, let alone any part he might have played in its genesis, would have barely registered with Koprowski when in 1986, an adventurous young man from the East End of London was happily indulging his love of Africa and his not insignificant love for African women. Based in Uganda, BBC World Service stringer Edward 'Ed' Hooper had already undergone one life changing experience - being locked up in a Ugandan jail for four weeks - and would shortly undergo another. In August, 1986 Hooper heard about an outbreak of disease on the shores of Lake Victoria on Uganda's southern border.

He travelled down to the small village of Kasensero and found that 100 people had died of a strange new illness he at once guessed was AIDS. Later he would say the experience had traumatised him, not least because the residents had asked him what they should do to protect themselves and the best he had been able to come up with was advice not to have unprotected sex.

He began to dedicate his life to tracking the epidemic. First he wrote "Slim", a personal account that received some decent reviews but sold just a few hundred copies. In 1990 he moved on to a far more controversial project, an investigation he would call The River. The book, running to over 1000 pages, details not only the history of HIV and AIDS but also sets out the case against Hilary Koprowski in minute, highly readable detail. The paperback, which was published earlier this month, starts with an introduction, written by Bill Hamilton, suggesting Hooper receive a Nobel prize if the theory is proved and ends with a postscript reporting the scientist's death.

It is no exaggeration to say the publication of The River has caused a sensation in both the lay and professional press. Lauded by writers as a literary achievement - "a version of the Faust myth for our age" according to Giles Foden, "the investigative and revelatory text of the year" says Will Self - it has had fire poured down on it from a number of specialists who are either targeted or mentioned in its pages. In the course of researching this article it has been described variously, by scientists, as "a conspiracy theory", "boring", "sanctimonious bullshit", "hysterical", "innuendo on innuendo" and "very unlikely." It has also led to vials of Koprowski's vaccines being taken out of storage and sent to independent laboratories for testing. And then there was Hamilton, the universally acclaimed naturalist, who died in an attempt to prove Hooper right.

Tracking down Hooper to the incongruous setting of Hay-on-Wye where he was speaking at the village's annual literary festival, I found him in a restaurant holding forth on the Bonobo chimp's penchant for anal sex. Scruffy, rounded and unshaven, Hooper has a manner that is both tetchy and ingratiating at the same time. A further, strong trace of paranoia should be forgiven him given the firestorm that surrounds him. He said his obsession was partly due to being healthy and HIV free: "Several of my former lovers have since died of AIDS," he told me. "So I felt I had dues to pay."

At first the dues were to write an uncontroversial book that would trace HIV back to source, hence the title The River. He wanted to answer the question "Why Now?" - planning to spend 16 months on the project. As he went about his task, busily discarding all the loopy theories he came across, he found the polio vaccine theory the most difficult to knock down. It was being promulgated by a shadowy figure calling himself Louis Pascal who would write long and angry articles to anyone who would listen. Despite Pascal's cranky nature, Hooper felt his words had merit.

As time passed, and Hooper conducted around 600 interviews around the world and he grew more and more convinced of Pascal's claims. Soon he found himself at the forefront of those who believed in the theory. For some reason Pascal grew silent and Tom Curtis, the journalist who wrote the article in Rolling Stone was effectively silenced when Koprowski sued the magazine. Only Hooper remained, busily running the virus back into the heart of Central Africa.

On the way he scored a number of great breakthroughs. A committee set up by the Wistar in response to the Rolling Stone article rejected the theory on the basis of a Manchester man who seemed to have contracted HIV before the polio vaccines were fed. Hooper helped prove to everybody's satisfaction that the man had been misdiagnosed.

MOST SCIENTISTS are now certain HIV jumped from chimpanzees to humans. Genetic analysis has shown that the simian immunodeficiency virus in the common chimp is closest relative to HIV-1m - the strain that has caused the pandemic. A lesser HIV2 affects the west of Africa and jumped, Hooper suggests by a different polio vaccine, from sooty mangabey monkeys. Conventional thinking goes that a hunter butchering a chimp contracted the virus through a cut and that this was not unusual, the leap between species having happened many times in history. It is only now, with modern population movements and immunisation programs in Africa, that the virus has failed to die out, instead leaping borders and continents, blossoming into a pandemic that has so far engulfed 55 million and killed 16 million people. It's a convenient theory of course, because nobody's to blame. After all it wouldn't do in our brave new world to think that something darker may have happened. It is here that Hooper points out that population movement in Africa is nothing new - look at the slave trade for example. He began to draw dots on the map of the Congo, that vast rain-forested morass of disease and conflict, illustrating the most circumstantial, yet most compelling, evidence of a man-made disaster.

Hooper points out that Koprowski, after dosing that first child in upstate New York, went on to develop another experimental polio vaccine he called CHAT that would end up being tested on more than 900,000 people in the Congo, Burundi and Rwanda between the years 1957 to 1960. The first confirmed case of HIV is from a man whose blood was taken in the capital of the Congo in 1959. Of the 28 confirmed cases of HIV and AIDS that emerged in specific towns in Africa before and during 1980 a full 23 were in the very towns (or with 175 miles) that the vaccine had been tested.

Leaving aside the claim (refuted by Koprowski) that 95% of the African children were already immune to polio and the trial held no health benefits, Hooper exposes a terrifying laissez-faire approach by the researcher. Not only did Koprowski fail to follow up these trials properly but nowhere at the time did he say what the vaccine had been grown in; which is now a key issue because the vaccines are grown in the minced kidneys of monkeys. Was it possible that the scientist used the chimpanzees that carry the ancestor of HIV to grow his vaccine? "No," said Koprowski. "Yes," says Hooper.

Hooper shows that Koprowski had not only the means but also the knowledge to use chimp kidneys as a growing agent for his vaccine. Koprowski himself told Hooper that that he had spent several days with a vet who had grown polio vaccines in the kidneys of a number of African primates, among them chimpanzees. Hooper argues that this offered Koprowski first hand knowledge.

What is more, Koprowski had chimpanzees at hand. In 1956 he had set up a camp at Lindi 10 miles down river from Kisangani (the town where Kurtz had his camp in Conrad's Heart of Darkness) which would house nearly 400 chimpanzees. The camp was constructed to test the effectiveness of Koprowski's vaccine yet, for some reason nearly all the animals at the camp were killed. Hooper has found a worker there who told him their organs were cut out and taken away along with their blood. Again it is a side issue, but given that the chimps had to be alive during this procedure, the methods used on our tree-dwelling cousins were horrific.

So rather than a hunter picking up the virus, Hooper argues that Koprowski, busy in a race with Albert Sabin, used kidneys from his chimp camp at Lindi, not knowing that several of the animals harboured a simian virus as yet unknown to mankind. When he administered the resulting vaccine into the mouths of hundreds of thousands of Africans, the hidden virus took advantage of the mouth ulcers, sores or bitten lips to jump species. Then, when it seeded well, HIV broke out and spread. Looking at the maps and the evidence gathered over 10 long years, Hooper had Hamilton convinced. "To my mind it is by far the most plausible theory of how the disease got started," he told CNN in the last interview he ever gave. But there are other voices, other very strong voices. "Just because you spend 10 years on a piece of shit doesn't mean it's not shit," said Beatrice Hahn, a microbiologist at the University of Alabama, who is one of the great experts on both the human and the chimp virus.

THERE are two groups of scientists who reject Hooper's hypothesis. The first are those who are associated with Koprowski. The second are those currently working in the field who claim not to have any axe to grind in the debate. A third group remain sceptical but opened minded while a fourth group is supportive to varying degrees. There are only a handful of important figures in the first, second and last group. The others crowd in the third group, which contains practically every professional scientist with an interest. Before he died Bill Hamilton organised a meeting of the Royal Society to discuss and debate Hooper's theory.

Originally it was to have taken place in May but Hamilton's death, added to the need for negotiations to ensure the participation of all parties and the expectation of the test results from the Wistar, has meant it will be delayed until September. While Koprowski has said he plans to attend, Stanley Plotkin, his old colleague at the Wistar who has a chapter dedicated to him in Hooper's book, will speak on his behalf.

Calling from Paris where he was handing out several hundred diplomas, Plotkin, until recently head of the pharmaceutical giant Pasteur Merieux, summed up the core of the argument he plans to present. "Hooper has no solid evidence that chimpanzee cells were ever used or even a motive to why they would have been" he said. " Secondly I think the alleged incidence of vaccination and putative early cases of AIDS is false, illusory and invalid."

While these statement at first sight seem to be straightforward denial of the evidence Hooper has amassed, it is clear that the second group, the scientists who are currently working in the field, are readying themselves to go against Hooper in the September battle. "Look at his table, at the Katanga cases he lumps in this one corner of Congo," said Hahn. "You will find the evidence that polio vaccine was given here is based solely on a newspaper interview where Stanley Plotkin said he thought he was going to vaccinate there. There was no evidence that vaccine was ever given yet Hooper puts it into his table as 65,000 people being vaccinated there."

She turns to another case, this time in Kikwit, and calls it "total conjecture". "All other cases congregate round the Congo river," she said, pointing out the river is one of the great people carriers across the centre of Africa.

The attack on these two events is interesting because Hooper views them as highly significant. The case in Kikwit involved a Belgium cartographer and his Congolese wife who both developed AIDS in the early 1980s long after they had left the Congo. Records show the cartographer had a hernia operation in Kikwit in 1958. As it happened Stanley Plotkin had vaccinated both blacks and whites there in 1959. "The key thing is that there is an astonishing correlation," said Hooper.

The second major battlefield revolves around the location of the chimps that carry the simian ancestor virus. Hahn believes the chimps around Kisangani and the Koprowski's Lindi camp do not even carry the ancestor virus but rather that it emerged from troops in West Central African countries of Gabon, Cameroon and West Equatorial Guinea. It was in his attempt to prove Hahn wrong that Bill Hamilton spent most of January in the forests around Kisangani collecting chimp faeces for analysis. Nothing has yet come of those samples.

It is here that Hahn's argument begins to seem jarring to the lay eye. Given that there is no controversy over where people starting dying of AIDS, its seems odd that Hahn places the jump from chimp to man over 1,000 miles to the west. "If you look at the early epidemiology of HIV- 1m it is absolutely clear that it emerged from the former Belgium Congo and not French Equatorial Africa," said Hooper. "The epidemic starts in a completely different place from where they say the hunter who cut himself comes from."

Hahn responds by saying that outbreaks are unpredictable in their early stage and the virus could easily have been carried east. "It was transported east by a human to where the conditions were favourable for an epidemic outbreak," she said. "I mean, you don't have chimps in Thailand do you? And yet you have an epidemic there."

And then there is Bette Korber, a scientist based in Los Alamos who has used a supercomputer called Nirvana to come up with the date of 1930 as the year when all the strands of HIV-1m were the same. She calles it the Eve virus.

While on the face of it this seems to batter the polio vaccine theory (Koprowski was still in short trousers in 1930), Hooper argues that it offers him no difficulty, the virus could have already split into subtypes by the time it was passed through the vaccine. What's more Korber's former mentor at Los Alamos, Gerry Myers, agrees with Hooper and plans to speak on his behalf in September. "The supercomputer has little relevance," said Myers.

"I think there is a good chance Hooper's hypothesis is true." Korber is too polite to attack Myers - saying only that he is "much more taken" with Hooper's theory than she is. Other scientists are not so reticent. "Gerry Myers was out to lunch five years ago," said one.

In this era when the entire human genetic code is about to be mapped, when Dolly the sheep leads to a litter of cloned pigs, when live AIDS vaccines are being tested on humans, when genetically modified seeds are being planted without the knowledge of the farmers, when surgeons are nothing short of desperate to begin xenotransplantation and start saving lives with pig's innards, Hooper offers us the possibility that a scientific error turned sex into death for a generation. It was striking that very few of the scientists interviewed for this article were gung-ho about using animal organs in human transplants. Beatrice Hahn said: "People cannot expect to have medical experimentation and reap the benefits without taking a risk". So, presuming the Wistar vaccine tests prove nothing as they are expected to do, what of the theory that Koprowski's live polio vaccines gave mankind AIDS?

The panel convened by the Wistar after the Rolling Stone article concluded that "almost every step of this hypothetical mode of transmission is problematic". Plotkin, asked if it is possible, just said "No". Myers said it made sense to him. Hamilton thought it highly plausible. And Robin Weiss, one of the organisers of the September conference and yet another of the world's most respected scientists, believes Hooper should be thanked for making sure the question is at least tested: "If Hooper had not written this book they wouldn't be analysing these samples," he explained.

The point is it's plausible. That is what annoys the scientists so much. They can't knock down a theory that, tenuous or not, links up to suggest they got it wrong. But come September, Hooper will have to work hard to shift the public's view away from the so-called 'cut hunter theory' and create a widespread belief in the theory that a badly-made vaccine, created for the good of mankind, gave us an epidemic. To do that I think he will have to do one very difficult thing, and that is convince Beatrice Hahn that he is right. So far all Hahn believes is that it was a very close run thing.

"It may have been a close shot," she says candidly. "If African Green Monkey Virus had been suitable to infect humans, we could have introduced it when AGM kidneys were routinely used for polio vaccine later on, so it was a close shave." It is all so reassuring for you and me.